relationship of dyspnea and disease severity with anthropometric indicators of malnutrition among patients with chronic obstructive pulmonary disease

Objective: To find the association of dyspnea and disease severity with anthropometric indicators of malnutrition among chronic obstructive pulmonary disease patients

Methods: The cross-sectional analytical study was carried out at Sir Ganga Ram Hospital, Lahore during October 2013 to December 2014. Total 138 adult patients with severe COPD were enrolled. The severity of disease was measured by global initiative for chronic obstructive lung disease criteria; and dyspnea was assessed by modified medical research council dyspnea scale. Anthropometric indicators of malnutrition such as body mass index [BMI] and mid upper arm circumference [MUAC] were measured to evaluate the nutritional status of COPD patients. Data was analyzed by using Statistical Package for Social Sciences version 20

Results: The mean age of 138 patients was 55±3 years. The frequency of male patients [76.8%] was threetimes higher than female patients [23.2%]. The overall frequency of underweight patients measured by BMI was 44%, which was increased to 92% undernourished patients by using MUAC. When compared with female patients, the male patients showed lower means of BMI, MUAC, FEV1% and FEV1/FVC ratio. The significant relationship of high grade dyspnea with BMI [p=0.001], and MUAC [p=<0.001] revealed that malnourished COPD patients had more shortness of breathing as compared to normal-weight patients. Similarly, the association of FEV1% with BMI [p=0.001], and MUAC [p=<0.001] showed that malnourished patients had very severe type of COPD than normal-weight patients

Conclusion: Dyspnea and severity of disease had significant association with BMI and MUAC among COPD patients. Thus, assessment of nutritional status by measuring BMI and MUAC should be considered to predict the severity of disease among adult COPD patients

Therapeutic outcome of Pulmonary tuberculosis in type-2 diabetes patients

Objective: Tuberculosis is a major cause of morbidity and mortality and diabetes is a leading risk factor of tuberculosis. Co-existence of tuberculosis and diabetes may increase the disease severity and worsen the treatment outcome. Therefore, objective is to find the anti-tuberculosis treatment outcome among pulmonary tuberculosis patients with or without diabetes mellitus; and to see the drug resistance pattern among treatment failure cases in both groups

Methodology: The cross-sectional study was carried out at PHRC Research Center FJMU Lahore in collaboration with PHRC TB Research Centre KEMU Lahore during the year 2013-14. The data of 268 patients including 187 pulmonary tuberculosis patients without diabetes and 81 with diabetes was analyzed. Anti-tuberculosis treatment according to current guidelines of Directly Observed Therapy [DOT] was provided to all patients; and were assessed for improvement of AFB smear; AFB culture and Chest X-Ray before and after four months of starting ATT. Data were analyzed by using Statistical Package for Social Sciences version 20

Results: Mean age of non-diabetic TB patients was 36+/-16 years; and of diabetic TB patients was 50+/-12 years. Mean duration of diabetes was 6+/-4 years. Other characteristics included 57.8 percent males, 42.2 percent females, and 53.7 percent had history of contact. Cough, expectoration, fever and weight loss were commonly occurring symptoms. Infiltration [76.1 percent] was the commonest type of lesion followed by consolidation [14.6 percent] and cavitation [9.3 percent]. Findings of AFB Smear conversion, AFB Culture, and Chest X-ray were improved with time in both groups; and rates of improvement were significantly higher among non-diabetic TB patients [p <0.05]. The frequency of drug resistance was lower among non-diabetic TB patients [7.0 percent vs. 19.8 percent] but the difference was insignificant. The rates of drug resistance and MDR were considerably higher among patients with poor glycemic control [p 0.036]

Conclusion: Therapeutic outcome of pulmonary tuberculosis was poor among diabetic TB patients as compare to non-diabetic TB patients. Therefore, along with anti-tuberculosis treatment, improvement of glycemic control must be considered among diabetic TB patients for better treatment outcome and reduced drug resistance rate

Role of mycobacterium culture in the diagnosis of smear negative pulmonary tuberculosis suspects attending tertiary care setting

Sputum smear testing for acid fast bacilli is the gold standard for the diagnosis of tuberculosis. The role of culture in cases that are negative on sputum smear testing is being emphasized for early diagnosis of disease and prompt initiation of treatment. To correlate the role of culture in diagnosing smear-negative pulmonary tuberculosis suspects. Descriptive study carried out in chest clinic of Sir Ganga Ram Hospital, Lahore in collaboration with Institute of Public Health Lahore from January 2012 to June 2012. Materials and Adults over 15 year of either gender having symptoms and X-ray findings consistent with pulmonary tuberculosis were selected. The sputa of sputum smear negative cases were inoculated on Lowenstein-Jensen medium culture medium to isolate the organism and correlate the culture positivity and negativity in smear negative cases. A total of 88 sputa were negative for acid fast bacilli on smear which were subjected to culture on Lowenstein-Jensen medium. Of these 31[35%] grew acid fast bacilli and were thus confirmed positive by culture while rest 57 remained negative on culture. There was no significant difference in the symptoms and extent of lesions on X-ray between those who were culture positive or negative. Sputum culture should be done for the diagnosis or exclusion of smear negative clinically suspected and X-ray positive cases of pulmonary tuberculosis. Policy message: All clinically suspected and X-ray positive but sputum smear negative cases should undergo sputum culture for Mycobacterium tuberculosis on Lowenstein-Jensen medium. The facilities to culture the micro organism should be made available at district level by the tuberculosis control program

Diabetic eye screening in Sir Ganga Ram hospital, Lahore

Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level [GOD-PAP] and glycosylated hemoglobin [Ion-Exchange Resin]. Arterial blood pressure was measured using digital apparatus [Oscillometric method]. Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences [SPSS-20]. The study included 41% males and 59% females. Mean age was 51 +/- 9 [33-67] years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes [p-0.010], poorly controlled diabetes [p-0.044] and hypertension [p-0.006]. Odd ratios [95% CI] showed that duration of diabetes [>/= 20 years], glycosylated hemoglobin [>/= 7.5%,]Systolic blood pressure [>/= 140 mm/ Hg] and diastolic blood pressure [>/= 90 mm/Hg] had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended

Pregnancy related medical problems at a tertiary care hospital

To estimate pregnancy related medical problems in cases visiting care hospital for antenatal care tertiary .Retrospective OPD based study done at medical research laboratory of Ganga Ram Hospital, Lahore from January 2011 to December 2011. A total of 1806 pregnant cases visited the biochemistry laboratory out of which 1000 cases fulfilled the criteria and had complete record available and were selected for analysis. Variable including hemoglobin, blood group and Rh factor, fasting and post prandial plasma glucose, viral markers like HBsAg, Anti-HCV and Anti-HIV l/ll and complete urine examination. Data was analyzed using Statistical Package for Social Sciences [SPSS-15]. The mean age of women was 25.4 +/- 4.29 years and 78.1% were between 21-30 years. The mean fasting and post parandial glucose levels were 84.03 +/- 15 mg/dl and 134.30 +/- 23 mg/dl respectively. Gestational diabetes mellitus was found in 96 cases [6.9%]. HBsAg was present in 1.2%, HCV in 8.5% and both B and C were present in 1 case. None had HIV l/ll infection. Blood group 'B' was commonest [34.2%], followed by group 'O' [30.6%], group 'A' [24.5%] and 'AB' [10.7%]. Rhesus factor [Rh] showed 94% Rh-positive cases and 6.0% Rh negative. Overall anemia was present in 61.1% cases with mild anemia in 87.5%, moderate in 12.2% and severe in 0.1%. Urinary tract infection was seen in 10.1 % cases. Anemia was common in pregnancy. Urinary tract infection [10%], hepatitis C virus exposure [8.5%] and gestational diabetes mellitus [7%] were common. Although the screening of HCV is not recommended internationally but the rate of HCV infection is on increase in Pakistan so there is a need of proper screening of HCV along with routine antenatal screening. It will help to identify asymptomatic women, who may benefit from antiviral therapy at a time when they are more receptive to medical intervention